目的:促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4)和糖尿病肾病(DKD)仍然存在争议,本研究分析了TSH与TSH之间的相关性,2型糖尿病(T2DM)患者FT3、FT4和DKD。
方法:T2DM患者(1216例)根据血清TSH分为5组,FT3和FT4水平,尿白蛋白排泄率(UACR)的差异,比较估计的肾小球滤过率(eGFR)。二元logistic回归验证了TSH,FT3、FT4和UACR,eGFR。使用受试者工作特征(ROC)曲线分析DKD的TSH和FT3预测值。
结果:亚临床甲状腺功能减退和明显甲状腺功能减退的T2DM患者中,eGFR降低的白蛋白尿患病率高于甲状腺功能正常的患者。TSH与UACR呈正相关(r=0.133,p<0.001),与eGFR呈正相关(r=-0.218,p<0.001),FT3与UACR呈负相关(r=-0.260,p<0.001),与eGFR呈正相关(r=0.324,p<0.001)。随着TSH从低常值水平向升高水平的变化以及FT3从高常值水平向降低水平的变化,白蛋白尿的患病率逐渐升高,在TSH组和FT3组中,eGFR降低的患病率逐渐升高.在调整了年龄之后,BMI,糖尿病的持续时间,TPOAb,TGAb,吸烟,饮酒,高血压,使用抗糖尿病药物(二甲双胍,钠-葡萄糖协同转运蛋白2抑制剂),HbA1c,CRP,TC,TG,LDL-C,和HDL-C,TSH和FT3均与UACR增加相关(TSH:OR1.253,p=0.001;FT3:OR0.166,p<0.001)和eGFR降低(TSH:OR1.245,p<0.001,FT3:OR0.579,p<0.001),但是在男性中没有发现TSH与eGFR<60mL/min/1.73m2的相关性。FT3的ROC曲线下面积(AUC)大于TSH(FT3:0.64;TSH:0.61)。
结论:在T2DM患者中,TSH水平升高和FT3水平降低与DKD相关,而是以性别依赖的方式。FT3对DKD有较高的预测价值。
OBJECTIVE: The relationship between thyrotropin (TSH), free
triiodothyronine (FT3), free thyroxine (FT4) and diabetic kidney disease (DKD) is still controversial, and this study analyzed the correlation between TSH, FT3, FT4 and DKD in patients with type 2 diabetes mellitus (T2DM).
METHODS: T2DM patients (1216) were divided into five groups based on serum TSH, FT3, and FT4 levels, differences in urinary albumin excretion rate (UACR), estimated glomerular filtration rate (eGFR) were compared. Binary logistic regression verified independent correlations among TSH, FT3, FT4 and UACR, eGFR. TSH and FT3 predictive values for DKD were analyzed using receiver operating characteristic (ROC) curves.
RESULTS: The prevalence of albuminuria with decreased eGFR was higher in T2DM patients with subclinical hypothyroidism and overt hypothyroidism than that in patients with normal thyroid function. TSH positively correlated with UACR (r = 0.133, p < 0.001) and positively correlated with eGFR (r = -0.218, p < 0.001), FT3 negatively correlated with UACR (r = -0.260, p < 0.001) and positively correlated with eGFR (r = 0.324, p < 0.001). With the change from the lower normal level to the increased level of TSH and the change from the higher normal level to the reduced level of FT3, the prevalence of albuminuria gradually increased, the prevalence of decreased eGFR gradually increased in TSH groups and FT3 groups. After adjusting for age, BMI, duration of diabetes, TPOAb, TGAb, smoking, drinking, hypertension, the use of anti-diabetic medications (metformin, sodium-glucose cotransporter 2 inhibitors), HbA1c, CRP, TC, TG, LDL-C, and HDL-C, both TSH and FT3 correlated with increased UACR (TSH: OR 1.253, p = 0.001; FT3: OR 0.166, p < 0.001) and decreased eGFR (TSH: OR 1.245, p < 0.001, FT3: OR 0.579, p < 0.001), but this correlation of TSH with eGFR < 60 mL/min/1.73 m2 was not found in male. The area under the ROC curve (AUC) for FT3 was greater than that for TSH (FT3: 0.64; TSH: 0.61).
CONCLUSIONS: Increased TSH and reduced FT3 levels were associated with DKD in T2DM patients, but in a sex-dependent manner. FT3 had a higher predictive value for DKD.